House hearings begin on Medicaid expansion

Rudi Keller

Friday

Sep 27, 2013 at 12:01 AMSep 27, 2013 at 1:00 PM

JEFFERSON CITY — A House committee studying Medicaid will work with a mid-November target date to craft a proposal that remakes the federal-state health care program to more closely resemble private health insurance plans.

At the first of what will be at least seven hearings, the House Interim Committee on Medicaid Transformation heard testimony that expanding coverage to an estimated 300,000 more Missourians would give any plan a better chance of winning federal approval.

Saint Louis University law Professor Sidney Watson asked the committee to view Medicaid like an old-style diner, where each plate was built from a choice of meats and vegetables that could be ordered in any combination.

Under the 2010 Affordable Care Act, expanded Medicaid coverage to 133 percent of the federal poverty guideline was offered as a way for states to provide coverage to their poorest residents. Many aspects of the program are negotiable, she said, such as asking for items not on the menu at the diner. Expansion is different, she said.

"The state's option here is like broccoli," she said. "You have got to choose 133 percent."

During the hearing, Chairman Jay Barnes, R-Jefferson City, set Oct. 15 as a deadline for committee members to put forward ideas for the program. The committee will meet again that day and five more times during the ensuing month trying to write a bill.

"We are going to limit testimony to the actual proposals before the committee and expert testimony on the topics they propose," Barnes said.

Yesterday's hearing was to set the tone for those discussions. Many aspects of the Affordable Care Act, also known as Obamacare, take effect on Jan. 1. Medicaid expansion to cover millions of low-income working adults was a key aspect of the law, but only 26 states have accepted the deal with full federal funding for three years. After that, the states pay a small share until they eventually cover 10 percent of the total for the newly eligible.

In Missouri, Medicaid covers more than 850,000 people at an annual cost to state and federal taxpayers of $8.9 billion. Eligibility is based on income, with the most generous limits for pregnant women and children. Adults with children can obtain coverage if their income is less than $292 a month for a family of three. Childless adults get no coverage now.

Expansion doesn't mean wealthy families get free care, Barnes said.

"It is geared at people who, by definition, are working," Barnes said. "I don't think there are many trust fund babies at 50 percent of federal poverty level. Typically, they have income, and someone at that income doesn't have it from a trust or a bank account; they have it from manual labor."

Committee members talked about plans developed in Arkansas and Iowa, as well as adaptations of national proposals for Medicaid changes.

Rep. Chris Kelly, D-Columbia, said reaching goals for combating waste, making recipients more responsible for health decisions and expanding the program requires cooperation.

"We have Democrats who will never admit the existence of bathwater and Republicans who will never admit the existence of babies," Kelly said. "We need to figure out a way to throw out the bathwater while keeping the baby."

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